Clinical Anatomy of Jaundice II Flashcards
Describe the different ducts that form the biliary tree.
The biliary tree is made up of: Right and left hepatic ducts unite to form the common hepatic duct Common hepatic duct unites with the cystic duct to form the bile duct
What is the function of the biliary tree?
The biliary tree is responsible for transporting bile
State the four parts of the duodenum and their relationship with peritoneum
Superior (part intraperitoneal) Descending (retroperitoneal) Horizontal (retroperitoneal) Ascending (retroperitoneal)
Where does the duodenum begin and end?
Begins at the pyloric sphincter Ends at the duodenal-jejunal flexure
What hormones does the duodenum secrete into the blood?
Peptide hormones (gastrin and CCK)
Name the different parts of the pancreas
Head (with uncinate process) Neck Body Tail
State the different anatomical relationships of the pancreas
Right kidney, left kidney, IVC, bile duct, abdominal aorta and superior mesenteric vessels all lie posterior Stomach lies anterior Splenic vessels lie superoposteriorly Duodenum surrounds the head
Name the organs shown in this picture
1) Right kidney
2) Liver
3) Pancreas
4) Abdominal aorta
5) Stomach
6) Left kidney
7) Spleen
State the different functions of the pancreas
Exocrine - acinar cells dump their enzymes into the pancreatic duct
Endocrine - islets of Langerhans dump their hormones into the blood
Describe the anatomy of the bile duct
The bile duct descends posteriorly to the first part of the duodenum
It then travels into a groove on the posterior aspect of the pancreas and joins with the main pancreatic duct - forms the ampulla of Vater
Describe the process of carrying out endoscopic retrograde cholangiopancreatography (ERCP)
Endoscope inserted into the duodenum via the oral cavity
Cannula placed into major duodenal papilla and radio-opaque dye injected back into biliary tree
Radiographic images are taken
List some causes of jaundice
Gallstones - cause blockage of bile back to liver causing overspill into blood
Carcinoma at head of pancreas
Extrahepatic causes
State the arteries that supply the duodenum and pancreas
Gastroduodenal artery (branch of common hepatic artery)
Splenic artery
Dorsal pancreatic artery
Superior mesenteric artery
Superior & inferior pancreaticoduodenal arteries (anastomose)
Explain the cause and presentation of pancreatic pain
Pancreatic pain is secondary to pancreatitis - often caused by blockage of the ampulla causing bile to be diverted into the pancreas
The pancreas is a foregut & midgut organ meaning pain can present in the epigastric and/or umbilical region
Describe the different signs of acute pancreatitis
Grey-Turner’s sign - blue bruising around the flanks
Cullen’s sign - blue bruising around umbilicus
State the main differences between the jejunum and the ileum
Jejunum is deep red in colour while ileum is lighter pink
Jejunum has a thicker/heavier wall
Jejunum is more vascular
Jejunum has less mesenteric fat
Jejunum has large, tall and closely pack folds while ileum has low and sparse folds
Ileum has lymphoid tissue in Peyer’s patches, jejunum has no lymphoid tissue
State the blood supply of the jejunum and ileum
Jejunum and ileum are supplied arterial blood from the superior mesenteric artery via jejunal and ileal arteries
Jejunum and ileum are drained by jejunual and ileal veins to superior mesenteric vein to hepatic portal vein
Describe the anatomy of the superior mesenteric artery
The SMA leaves the aorta at L1 and runs posterior to the neck of the pancreas. It travels in an inferior direction, anterior to the uncinate proccess of the pancreas before entering the mesentery proper
State where fat is absorbed to
Fat is absorbed into intestinal cells (with help of bile). It is passed to lacteals (specialised lymphatic vessels) before traveling via the lymphatic system. The fat then drains into the venous system at the left venous angle
Describe the lymphatics of the abdomen
Lymph vessels tend to run alongside their associated abdominal arteries
The lymph nodes draining abdominal organs include:
Coeliac - drains foregut
Superior mesenteric - drains midgut
Inferior mesenteric - drains hindgut
Lumbar - drains kidneys. pelvis and lower limbs
